上海市浦东新区儿童支气管哮喘分级诊疗模式效果评价  

Evaluation of the effect of hierarchical diagnosis and treatment model of childhood bronchial asthma in Shanghai Pudong New Area

作　　者：刘世英 殷勇[1] 张芬[1] 张皓[1] 张磊[1] 张静[1] 袁姝华[1] 邬宇芬[1] 唐铭钰[1] 赵丽霞[1] 王东 童星 Liu Shiying;Yin Yong;Zhang Fen;Zhang Hao;Zhang Lei;Zhang Jing;Yuan Shuhua;Wu Yufen;Tang Mingyu;Zhao Lixia;Wang Dong;Tong Xing(Department of Respiratory Medicine,Shanghai Children′s Medical Center Affiliated to Shanghai Jiaotong University School of Medicine,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属上海儿童医学中心呼吸科,200127

出　　处：《中华实用儿科临床杂志》2021年第16期1235-1239,共5页Chinese Journal of Applied Clinical Pediatrics

基　　金：上海市科委"科技创新行动计划"生物医药领域科技支撑项目(19441909000);上海浦东新区卫生和计划生育委员会卫生计生科研项目(PW2017E-1)。

摘　　要：目的评价上海市浦东新区儿童支气管哮喘分级诊疗模式的效果。方法根据就近原则,将2016年7月至2017年5月在上海儿童医学中心确诊为支气管哮喘的6个月~17岁患儿分为专科医院组和社区医院组2个队列,进行12个月的治疗和随访。收集哮喘控制水平、儿童哮喘控制测试(C-ACT)评分、用药依从性及卫生经济学指标。结果分析524例患儿数据,其中专科医院组300例,社区医院组224例。按全球哮喘防治创议(GINA)标准,2组每月哮喘控制水平差异均无统计学意义(均P>0.05),第12个月专科医院组良好控制率提高12.4%(P<0.01),社区医院组提高22.9%(P=0.015);按C-ACT标准,2组患儿每月良好控制率差异均无统计学意义(均P>0.05),呈逐月上升趋势。分级诊疗第12个月时专科医院组和社区医院组依从性良好患儿比例分别为78.3%(235/300例)和75.0%(168/224例),差异无统计学意义(P=0.370)。分级诊疗12个月后,专科医院组和社区医院组患儿哮喘发作次数分别为1.0次和2.0次(P=0.269),哮喘住院率分别为3.0%(9/300例)和4.9%(11/224例),差异无统计学意义(P=0.259);专科医院组呼吸道感染次数(2.0次)低于社区医院组(3.0次)(Z=-3.308,P<0.05),社区医院组总治疗费用(2471.5元)低于专科医院组(3445.5元)(Z=-3.336,P<0.01),差异均有统计学意义;分级诊疗12个月后专科医院组和社区医院组患儿哮喘发作次数、呼吸道感染次数、因哮喘住院率均较分级诊疗前12个月下降,差异均有统计学意义(均P<0.01)。结论上海浦东新区儿童哮喘分级诊疗模式可改善哮喘控制水平、C-ACT评分、哮喘药物治疗依从性,提高卫生经济学效益,是儿童哮喘治疗管理的有效途径。Objective To evaluate the effect of hierarchical diagnosis and treatment model of childhood bronchial asthma in Shanghai Pudong New Area.Methods According to the principle of proximity,children aged 6 months-17 years who were diagnosed with bronchial asthma at Shanghai Children′s Medical Center from July 2016 to May 2017 were divided into two cohorts:the specialized hospital group and the community hospital group.Twelve months of treatment and follow-up were conducted.The asthma control level,Childhood Asthma Control Test(C-ACT)score,medication adherence and health economic indicators were collected.Results A total of 524 children were included for data analysis and divided into the specialized hospital group(300 cases)and the community hospital group(224 cases).According to the Global Initiative for Asthma(GINA)criteria,there was no statistical difference in monthly asthma control level between the two groups(all P>0.05).In the 12th month,the well-controlled rate of the specialized hospital group increased by 12.4%(P<0.01),and that of the community hospital group increased by 22.9%(P=0.015).According to the C-ACT criteria,there was no statistical difference in the monthly well-controlled rate between the two groups(all P>0.05),and the rate maintained an upward trend.The rates of patients with good compliance in the specialized hospital group and the community hospital group at the 12th month of hierarchical diagnosis and treatment were 78.3%(235/300 cases)and 75.0%(168/224 cases),respectively,and the difference was not statistically significant(P=0.370).After 12 months of hierarchical diagnosis and treatment,the number of asthma attacks were 1.0 and 2.0(P=0.269),and the hospitalization rates for asthma were 3.0%(9/300 cases)and 4.9%(11/224 cases),respectively in the specialized hospital group and the community hospital group,and the diffe-rence was not statistically significant(P=0.259);the number of respiratory infections in the specialized hospital group(2.0 times)was lower than that in the community hospita

关 键 词：分级诊疗 儿童 哮喘 管理 前瞻性多中心队列研究 

分 类 号：R725.6[医药卫生—儿科]